Motivational interviewing for vaccine hesitant parents

BACKGROUND: The widespread use of vaccines led to significant decline in multiple potentially fatal infectious diseases. Recently, there has been an increase in vaccine hesitancy. Measles and pertussis outbreaks throughout the United States have put a spotlight on this urgent healthcare issue. Motivational interviewing is a counseling tactic that is gaining popularity and is being studied for its efficacy in preventative medicine and psychological disorders. It aims to inspire people to make behavioral changes through collaborative relationships with their provider by understanding how current actions do not translate into their health goals. LITERATURE REVIEW FINDINGS: Vaccine hesitancy is growing. Communities with decreased immunization rates are associated with a higher risk of disease outbreak. Increasing rates of undervaccinated children are likely due to increases in non-medical exemptions. Many parents, regardless of their vaccine hesitancy status, are concerned about vaccine safety. Vaccine hesitant parents refuse vaccines due to philosophical and religious beliefs, conspiracy theories, and safety concerns. Parents feel that providers do not adequately address their concern. Providers report not having the training to discredit parental concerns. The majority of parents describe their child’s pediatrician as their most trusted source of vaccine information. Parents who receive vaccine information from a provider are more likely to comply with the recommended childhood vaccine schedule. The most efficient way to discuss vaccines with parents has yet to be determined. PROPOSED PROJECT: This is a proposed QI research project for the Pediatric Clinic at Boston Medical Center. Providers would be trained in motivational interviewing during several sessions that included lectures and small group practice sessions with systematic feedback. During the intervention, parents who refuse vaccines for their child, aged 0-6 years old, will receive motivational interviewing from the provider. The proportion of the vaccine hesitant parents who accept the offered vaccine after will be analyzed. The pre and post intervention vaccination rates for the entire clinic will also be assessed. Data collection will be preformed through retrospective chart review. The project aims to increase provider confidence on vaccine counseling, educate providers on reasons for hesitancy, and improve compliance with the CDC recommended vaccine schedule. CONCLUSION: While most Americans continue to vaccinate their children according to the CDC’s recommended schedule, constant vigilance is required to maintain high immunization rates to protect our communities. Motivational interviewing is goal-oriented to alter a specific behavior and would allow providers to engage in an open, persuasive dialogue about parental vaccine concerns

Form Regulation to Address New Construction in Historic Districts

This thesis will evaluate several tools that cities are currently using to regulate the form of new construction, large alterations, and additions in designated historic areas. A number of tools are available to achieve this type of regulation, but the most popular tools tend to be place-specific design guidelines derived from the study of a historic district, associated with an overlay designation established by the city’s zoning code. Throughout this thesis, this type of regulation will be referred to as “traditional tools.” “Non-traditional tools,” as used herein, include things like form-based codes or neighborhood conservation districts. These are tools that have not been as widely used or are relatively new to the regulatory landscape. The tools evaluated in this thesis will be examined through case studies and include a mix of traditional tools and non-traditional tools. The traditional tool case studies are New Orleans, LA, and Savannah, GA. The non-traditional tool case studies are Beaufort, SC, which is used a case study for both traditional and nontraditional tools, and Philadelphia, PA

In Memoriam: Ruth Bader Ginsburg

On September 18, 2020, we mourned the loss of Justice Ruth Bader Ginsburg, whom many considered not just a cultural icon, but a national treasure. Among many other things, Justice Ginsburg became a later-in-life feminist “rock star,” celebrated for her rousing and impassioned dissents, her fearless defense of equality and autonomy rights, her championing of civil rights, and her persistent determination in the face of injustice. RBG’s pop-culture status led to books, movies, t-shirts, “dissent collar” accessories, and Halloween costumes. But long before she became “notorious,” she was a daughter, a mother, a law student, an advocate, a professor, a judge, and then—finally—a Justice. In this Essay, I will reflect on the opinion that manifests her life in all those roles and stands in many ways as the culmination of her life’s work: United States v. Virginia (VMI)

Is the Family a Federal Question?

There has long been conflict over the relationship between the states and the federal system vis-i-vis the family. The traditional account of domestic relations describes family law as the exclusive domain of the states, and federal courts have credited this account in the domestic relations exception. Although scholars have analyzed and critiqued the exception\u27s applicability to diversity jurisdiction, the intersection of federal question jurisdiction and this exception remains largely unexplored. This Article describes and critiques, on both instrumental and deeper normative terms, federal courts\u27 willingness to expand the domestic relations exception to include federal question cases. The Article proceeds in three parts. In Part II, I describe the emerging trend in federal courts of avoiding decision on federal questions implicating the family, either by expanding the domestic relations exception, or by using other avoidance doctrines as proxies to accomplish the same result. I also explain how Supreme Court dicta in Elk Grove Independent School District v. Newdow has exacerbated this trend. In Part III, I assess critically how and why federal courts are avoiding these questions, considering the potential doctrinal and policy bases for an expansive exception, and evaluating its potential scope. I conclude that there is no principled doctrinal or policy basis for an expanded domestic relations exception that includes federal questions. Part IV shifts to a more normative perspective, evaluating whether federal courts should defer to the states when facing federal questions affecting the family. Here, I argue that there is instrumental and normative value in preserving a federal forum. I also maintain that, because an expanded domestic relations exception would subordinate litigants, cause expressive harm, and potentially trigger negative cultural consequences, federal courts should resist expansion. The Article concludes by reflecting on the implications of my analysis and emphasizes the important role of federal courts in supporting, empowering, and protecting contemporary American families

Childcare, Vulnerability, and Resilience

The question of how to provide care for America’s youngest children, and the quality of that care, is among the most vexed for family law. Despite seismic demographic shifts in work and family, childcare law and policy in the United States still operates on the assumption that childcare is the private responsibility of parents and families rather than a state concern. But this private childcare model, based on unrealistic assumptions in liberal theory and buttressed by an ascendant neoliberalism, is inadequate to today’s childcare challenges. This project confronts the inadequacies of the private childcare model. Using Martha Albertson Fineman’s Vulnerability Theory as its frame, this Article argues that the state’s role with regard to childcare should be primary, rather than supplemental or contingent. Recognizing the universal vulnerability of children and families and the potential for high‐quality care to promote resilience, the state has an obligation to provide the care and support necessary to ensure child wellbeing. With the development of a comprehensive, public childcare system, the state can partner with families to ensure that all children have access to quality childcare, and consequently, increased resilience with greater opportunities to develop and thrive

Outsourcing Childcare

Existing discourse on childcare decisions proceeds as if there were one right answer to the question of who should care for children. The law has preferences, too. But the reality is that parents, like businesses, make diverse, strategic decisions about when to keep work in-house, and when to collaborate with outside partners. This Article uses the lens of business outsourcing to gain fresh perspective on childcare decisionmaking, and the law\u27s relationship to it. The outsourcing framework provides three key insights. First, it enables us to better understand the diversity of childcare decisions and the reasons underlying them. Second, the outsourcing model rejects a one-size-fits-all approach to childcare, and instead respects and values a diversity of approaches. Third, the normative value in this diversity suggests a particular role for the law in interacting with childcare decisions. The law should accommodate and support a variety of approaches, rather than take a position on the substantive content of childcare decisions. Using this benchmark, this Article critically surveys existing law impacting childcare decisions and explores how it might evolve to better support the families making these decisions

Sexualization, Sex Discrimination, and Public School Dress Codes

This essay joins the conversation about sexualization, sex discrimination, and public school dress codes to situate current debates within in the broader cultural and legal landscapes in which they exist. My aim is not to answer definitively the questions I pose above. Rather, I ground the controversy in these broader contexts in order to better understand the stakes and to glean insights into how schools, students, and communities might better navigate dress code debates

The Effect of Hot Fill and Hold Processing on the Performance of Multilayer Packaging Films

Heat transfer in thermal processing is crucial to ensure all parts of a product are sufficiently treated to achieve commercial sterility without unacceptable loss of quality. Optimizing pasteurization methods is recommended to preserve quality attributes such as color, texture, and flavor while maintaining food safety integrity. This research evaluated the temperature variability in pouches during a hot fill and hold process and the effect of those identified differences on color quality of a tomato based food simulant. The performance of multilayer films for pasteurized products in accelerated storage conditions were also studied. The research project was separated into two phases. The objective of the first phase was to understand the profiles of heating and cooling in pouches processed in a simulated hot fill and hold process. The corners of the pouch were found to be the fastest cooling spot within the pouch (p\u3c0.05). The center of the pouch was found to have the highest mean temperature during the hold step of the process and had the slowest cooling rate in the pouch (p\u3c0.05). The trends of heating and cooling were also evaluated using a low viscosity food simulant. This study compared the time and temperature profiles for a static hot fill process versus a process that incorporated rotating the pouch 180° every 10 seconds. For the static hot fill and hold process, mean temperatures of the center and corners of a pouch showed non-uniform heat transfer during the holding period and cooling process. More uniform heating and cooling within pouches was achieved by implementing 180° rotation during processing